Inadvertent Postoperative Hypothermia at Post-Anesthesia Care Unit: Incidence, Predictors and Outcome

Background: Inadvertent postoperative hypothermia (IPH) is known to be associated with various adverse effects. The aim of this study was to evaluate the incidence, predictors and outcome of core inadvertent hypothermia on admission in the post-anesthesia care unit. Methods: Observational, prospective study in a Post-Anesthesia Care Unit. The study population consisted of adult patients after non-cardiac and non-neurologic surgery. Patients’ demographics, intraoperative and postoperative data were collected. Descriptive analysis of variables was used to summarize data and the Mann-Whitney U test, Fisher’s exact test or Chi-square test was used. Univariate and multivariate analyses were done with logistic binary regression with calculation of an Odds Ratio (OR) and its 95% Confidence Interval. Results: The incidence of IPH on admission was 32%. In univariate analysis: age, body mass index (BMI), high risk surgery, revised cardiac risk index (RCRI), type of anesthesia, use of forced-air warming, amount of intravenous crystalloids administrated, duration of anesthesia, duration of surgery and admission visual analogue scale (VAS) for pain > 3 were considered predictors of hypothermia. In multiple logistic regression analysis, age (OR 1.7, P = 0.045, for age > 65 years), RCRI (OR 3.18, P = 0.041, for RCRI > 2), duration of anesthesia (OR 1.52, P < 0.001) and admission VAS for pain (OR 2.05, P = 0.007) were considered independent predictors of IPH. Patients with IPH at PACU admission stay longer in the PACU. Conclusions: IPH was associated with a longer stay in the PACU. Age, comorbidities duration of anesthesia and pain at PACU admission were considered independent predictors for IPH.

Treatment of inadvertent subclavian artery cannulation with a percutaneous vascular closure device

Inadvertent puncture of the subclavian artery is an uncommon but potentially fatal complication of the commonly performed internal jugular vein catheterization.We report a case of accidental subclavian artery catheterization close to the vertebral artery during internal jugular venous cannulation,which was successfully managed in the interventional suite with catheter removal and use of a vascular closure device.

An approach to quantifying the plausibility of the inadvertent download defence

A table of 95%confidence limits on the probabilities for randomly downloading relatively small numbers of illegal images or sensitive documents amongst a relatively large number of other images or documents has been computed.It is anticipated that these data will assist prosecution officials in arriving at a decision as to whether or not there is a reasonable likelihood of a successful criminal prosecution when the inadvertent download defence is employed in cases of possession of child pornography,terrorist material or espionage-related documents.The same data can also be used by defence counsels to assess the strength of the prosecution’s case.

Percutaneous repair of inadvertent subclavian artery cannulation： a case report

Although catheterization of the subclavian vein is a common procedure, it might be associated with life-threatening complications including accidental cannulation of subclavian artery. Rash sheath removal could result in fatal hemorrhage. We report a case of inadvertent 6F sheath cannulation of the right subclavian artery during a radiofrequency catheter ablation procedure and successful repair of the cannulation by Angio-Seal STS plus （St. Jude Medical, St. Paul, MN, US）, a collagen-base vascular closure device.

Lethal Consequences in an Infant with Myelomeningocele Following an Inadvertent Treatment

Myelomeningocele(MMC)is a protrusion of spinal cord contents and meninges through a vertebral defect.Iatrogenic deaths of patients with MMC are rarely encountered in forensic practice.In our case,a 3‑month‑old female was born with a lumbosacral cyst,the size of which had been increasing gradually over age.There was no neurological,orthopedic,or urologic dysfunction.On the day of her death,she received a repetitive and rapid lumbosacral cyst puncture drainage procedure,performed by an illegal medical practitioner.Postmortem autopsy findings confirmed a diagnosis of MMC and the cause of death to be cerebellar tonsillar herniation.This is a pathetic case of preventable infant death.This report suggests that the possibility of MMC should be considered in infants born with a lumbosacral cyst,and aspiration is inadvisable.Besides,forensic autopsy has a valuable role in determining the exact cause of death,identifying,or excluding iatrogenic factors that may be relevant to death following a medical procedure.A final point is that prevention programs should be developed,especially by the health care sectors to reduce such tragedy.

Role of conspecifics and personal experience on behavioral avoidance of contaminated flowers by bumblebees

Pollinators use multiple cues whilst foraging in eluding direct cues from flowers and in direct cues from other pollinators. The use of indirect social cues is common in social in sects, such as honeybees and bumblebees, where a social environment facilitates the ability to use such cues. Bumblebees use cues to forage on flowers according to previous foraging experiences. Flowers are an essential food source for pollinators but also pose a high risk of parasite infection through the shared use of flowers leading to parasite spillover. Nevertheless, bumblebees have evolved behavioral defense mechanisms to limit parasite infection by avoiding contaminated flowers. Mechanisms underlying the avoidance of contaminated flowers by bumblebees are poorly understood. Bumblebees were recorded having the choice to forage on non-contaminated flowers and flowers contaminated by a trypan osome gut parasite, Crithidia bombi. The use of different treatments with presence or absence of con specifics on both con taminated and non-contami nated flowers allowed to investigate the role of social visual cues on their pathogen avoidance behavior. Bumblebees are expected to use social visual cues to avoid contaminated flowers. Our study reveals that the presence of a con specific on flowers either con taminated or not does not help bumblebee foragers avoiding contaminated flowers. Nevertheless, bumblebees whereas gaining experie nee tend to avoid their con specific when placed on contami nated flower and copy it whe n on the non-contami nated flower. Our experime nt suggests a detrime ntal impact of floral see nt on disease avoidanee behavior.